<head>
    <link rel="stylesheet" type="text/css" href="css\modal.css">
</head>
<div id="patientModal" class="modal fade" data-backdrop="static" data-keyboard="false" role="dialog">
    <div class="modal-dialog">
        <div class="modal-content">
            <div class="modal-header">
                <button type="button" class="close" data-dismiss="modal" ng-click="close()">&times;</button>
                <h4 class="modal-title">Add Patient</h4>
            </div>
            <div class="modal-body">
                <table>
                    <tr>
                        <td>
                            PID*:
                        </td>
                        <td style="width: 100%"><input type="text" ng-model="patientForm.id" ng-disabled="update"></td>
                    </tr>
                    <tr>
                        <td>
                            Birth date*:
                        </td>
                        <td><input type="date" ng-model="patientForm.birthDate"></td>
                    </tr>
                    <tr>
                        <td>
                            Prefix*:
                        </td>
                        <td><input type="text" ng-model="patientForm.prefix"></td>
                    </tr>
                    <tr>
                        <td>
                            First Name*:
                        </td>
                        <td><input type="text" ng-model="patientForm.first"></td>
                    </tr>
                    <tr>
                        <td>
                            Last Name*:
                        </td>
                        <td><input type="text" ng-model="patientForm.last"></td>
                    </tr>
                    <tr>
                        <td>
                            Ethnicity:
                        </td>
                        <td><input type="text" ng-model="patientForm.ethinicity"></td>
                    </tr>
                    <tr>
                        <td>
                            Gender:
                        </td>
                        <td><input type="text" ng-model="patientForm.gender"></td>
                    </tr>
                    <tr>
                        <td>
                            Address*:
                        </td>
                        <td><input type="text" ng-model="patientForm.address"></td>
                    </tr>
                </table>
            </div>
            <div class="modal-footer">
                <button ng-click="submitPatient()" type="button" class="btn btn-default" data-dismiss="modal" ng-hide="update">Submit</button>
                <button ng-click="updatePatient()" type="button" class="btn btn-default" data-dismiss="modal" ng-show="update">Update</button>

            </div>
        </div>
    </div>
</div>